Some one you care for is suffering from an eating disorder. We aim to help you to understand some of the treatment issues for anorexia nervosa. This is a brief summary and you may wish to read more on our information pages.
Denying the problem
Your loved one may deny that there is a problem. There are many reasons why this is so.
- They don’t understand what anorexia is. Perhaps they believe that anorexia is not being hungry; and they ARE very hungry although they are good at suppressing it.
- They feel shame for what they are doing.
- They may be afraid of putting on weight.
- Starving makes it hard for someone to think clearly.
- They do not feel thin even if they are very thin. At the early stage of treatment it is not always helpful to insist that their thoughts are irrational
- There are aspects of this eating disorder that are useful to them. For example they secretly feel special and superior because of their ability to control their eating. They may not be consciously aware of this however.
Part of treatment is to help your loved one to admit that they are struggling. Even if they agree that they have anorexia, it makes no difference to treatment outcomes. We at NCFED have found it helpful to give a more personal name to their struggles with food and control with other things. They need to know that treatment is not just forcing weight gain; it is focused on building self confidence and flourishing . A properly trained therapist can use Motivational Therapy to help a person express their deep concerns about change.
How Treatment Works
There is no known treatment that is guaranteed to work. Carers must be strong, and patient, since this illness can last a long time and can feel fierce. If one treatment doesn’t work, try another with help of a specialist who cares. Most people, even serious cases eventually recover, so please have hope. Recovered cases may or may not still have quirky food rules. There are no drugs we know that will help someone behave normally with food. Drugs are only useful if there are other problems such as severe OCD or serious depression. The decision to use medication depend on psychological assessment usually done by a psychiatrist. Force feeding, (enteral feeding via tube) is only done for people who are at serious medical risk.
Treatment for Anorexia must be fitted to the person and will depend on many things:
- How ill they are, and what behaviour they are doing to control their food intake such as purging. Whether they have exercise compulsions or other forms of obsessive compulsive behaviour. What other mental health struggles to they have, such as a history of trauma. Starving on its own causes mental issues such as depression and obsessive compulsive behaviour and some of these problems do resolve when someone is eating properly.
- Whether treatment should be in hospital, day care or outpatient is a decision based on medical risk. Outpatient treatment is always best, even though carers just want their loved one to be in a safe place. The shortest possible hospital stays are indicated for medical emergencies and for failed outpatient treatment. Carers who cope at home need a great deal of help to deal with anger, resistance, dependency and secrecy. There is no point in getting angry because these are known features of the illness. Family support is crucial. If this is not offered, please find a local parent’s group or find some carer counselling from an eating disorder expert.
- The first phase of Anorexia treatment will involve getting to know your loved one so that they can hopefully build up trust in the therapist. This will take time because the Anorexia “fights” back when it is attacked and tells the sufferer not to trust anyone. So there is a process of getting to know the therapist.
- Ideally a dietician will design a feeding plan carefully formulated on the sufferer’s current needs and stage of maturity. If weight is very low we would not expect someone to start eating normal meals at once which could be dangerous and there may be a need to supplement a food plan with liquid meals.
- During the initial weeks the therapist will also be doing “Motivational Therapy” which helps someone to accept their problem and decide to work with therapy rather than to fight it. Because the nature of Anorexia is to fight against therapy, weight may continue to be lost at first and you may be very worried about this. Hospital admission is always a useful stand-by in the early stages of treatment before your loved one is able to take back some control over their illness. Even with successful treatment, many people have had several hospital admissions at first before they decide that it isn’t useful to continue living like this.
- For some people the FIRST goal of treatment must be to help them stop losing weight. This might take time and they may or may not manage it on their own. Hospital treatment is a stand-by for weight loss and does not on its own provide a cure. We must make sure that your loved one is medically safe.
- Only after people stop losing weight can we give attention to weight gain, with careful re-feeding plans. These must be tailored by a dietitian because everyone’s needs are different. Re-feeding is ideally supported by psychological treatment, for the underlying problems that are keeping them stuck. We call these “maintaining factors.” One maintaining factor in anorexic is intrusive thinking and the presence of what we call “an Anorexic Voice” which tells them that if they start eating again they will never stop and they will become very fat. We can teach carers how to talk back to this “voice” in a way which is helpful.
Goals of Anorexia Treatment
The goals of treatment are not just to help someone gain weight.
We wish to help your loved one take care of him or her self properly, to eat a wide range of foods with other people, to ubild emotional resilience and to manage social anxieties that he or she may have. This will take time, and we know that this awful illness will try to fight back. Anorexia is not just a phase. It is a sign that your loved one feels unable to cope with normal life and relationships with other people and that they have very low self esteem. We will be aiming to help someone reach a TURNING POINT –meaning that they wish to recover and are not just passively accepting their treatment.
Many carers believe that because someone does well at school or in sports they are coping very adequately. They are not. People with anorexia are deeply perfectionist and feel inadequate no matter how well they do. Part of treatment involves helping someone to make mistakes without shame, to question the rules of the illness and in this way to be kinder themselves. Ideally therefore, therapy would continue beyond the time that weight is regained. Weight regain on its own doesn’t mean that someone has recovered. They will continue for a while to need emotional support. In practice, people with anorexia are discharged from inpatient care as soon as their weight becomes safe. This is not always helpful if your loved one is eating just to escape from scrutiny. Relapse is less likely to happen if he or she continues to see a therapist over a long enough period of time.
How treatment works
Carers are an important part of a treatment plan to help with resistance, food struggles and your own emotional needs. Ideally carers will be given guidance and advice on meal handling and other skills from an eating disorder professional. If you are not offered this, consider getting some help from BEAT or the NCFED; it may make all the difference to you and your family.
Carers also often believe that therapy is “not working”; that the therapist is “not right” or complain that the therapist is not disclosing important matters to the carers and has an unhealthy relationship with their loved one. Perhaps the sufferer is “doing things” which you believe they are not admitting to the treatment team. All of these concerns must be communicated in the right way; you may be right and you may not. A common problem in anorexia treatment is “splitting” where carers and sufferers are both competing for the attention of the therapist or the treatment team. This is not usually helpful. Many of these problems can be managed properly if you get the support of your own counsellor or support group.
A therapist may use different kinds of therapy to help your loved one overcome the underlying factors which make them need to starve. Cognitive therapy, treatment for trauma if there is one, dance and art therapy help your loved one express their feelings; general psychotherapy for coping skills- all can be useful. There are treatments that rely on carers to supervise every single meal and train carers to do this.
All these therapies take time to work and their effect differs from one person to another. If one therapy is not working, something else might. There is no one-size fits all treatment for anorexia, but keep going, remember that 8 out of 10 people eventually recover.
There is no escaping the fact that 1 in 5 sufferers do not recover and may die. To make this less likely, get help for the family. Think positive and remember that the statistics are on your side, no matter how serious the illness is. The illness lasts for on average 7 years with wide individual differences. We have seen people recover who have been in hospital many times. We also know that someone may be getting better before it shows up in weight gain and increased confidence.
What you need to do
If you are a carer you will need a great deal of help: to deal with your sadness, worry, confusion and grief. Please consider having a carers consultation with one of our specialists.
You need to learn about the illness. We have other information articles about anorexia treatment in our information pages, please read them all.
You need to learn how to speak to the person who is suffering in a way that is helpful. A properly trained therapist can guide you with this.
Have hope, this is a horrible illness that you would not wish on any family. But most people recover.
READ MORE see more about anorexia treatment here
Written by Deanne Jade, updated 2020